Central California Alliance for Health (Remote)
Lead Payer Analytics Consultant
Central California Alliance for Health (Remote), Boise, Idaho, United States, 83708
We have an opportunity to join the Alliance as a Lead Payer Analytics Consultant in the Payment Strategy Department. This position can be filled remotely within the Pacific or Mountain Time Zones.
WHAT YOU'LL BE RESPONSIBLE FORReporting to the Payment Strategy Director, this position will:
Functions as a strategic consultant to Alliance executive leadership in the areas of complex managed care payer financial modeling and statistical analysis to evaluate the feasibility of payer reimbursement methodologies.
Advises Alliance executive leadership on organizational decision-making through the performance of complex financial analysis to support successful payer reimbursement outcomes.
Acts as subject matter expert and collaborates with internal and external stakeholders to achieve payer reimbursement objectives.
Acts as a subject matter expert and lead to subordinate staff.
ABOUT THE TEAM
The Payment Strategy department ensures the Alliance's payments to our network are adequate to our revenue.
WHAT YOU'LL NEED TO BE SUCCESSFUL
Knowledge of:
Methods and techniques of financial modeling and analysis.
Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers.
Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types.
Healthcare financial statements and accounting principles.
Descriptive statistical techniques and terminology and the principles and practices of statistical analysis.
Methods and techniques of developing and delivering data management strategies that support contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations.
Thorough knowledge of the methods and techniques of valuating for physician and inpatient and outpatient hospital costs.
Ability to:
Collect, interpret, and evaluate data, detect patterns, brainstorm solutions, consider multiple factors when making decisions, and project consequences of recommendations.
Demonstrate strong analytical, critical thinking, and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action.
Translate data into understandable information and deliver solutions that improve business processes.
Act as a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs.
Lead, train, mentor and motivate staff, and promote an atmosphere of teamwork and cooperation.
Organize and prioritize the work of others and follow up on work assignments.
Education and Experience:
Bachelor's degree in Business Administration, Accounting, Finance, Healthcare, or a related field.
A minimum of eight years of experience performing financial healthcare reimbursement analysis (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying.
OTHER INFORMATION
We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
The full compensation range for this position is listed by location below.
The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).
OUR BENEFITS
Medical, Dental and Vision Plans.
Ample Paid Time Off.
12 Paid Holidays per year.
401(a) Retirement Plan.
457 Deferred Compensation Plan.
Robust Health and Wellness Program.
Onsite EV Charging Stations.
And
many more .
ABOUT USWe are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer.
Join us at Central California Alliance for Health (the Alliance), an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors, and people with disabilities in Mariposa, Merced, San Benito, and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our
Fact Sheet .
At this time, the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.
#J-18808-Ljbffr
WHAT YOU'LL BE RESPONSIBLE FORReporting to the Payment Strategy Director, this position will:
Functions as a strategic consultant to Alliance executive leadership in the areas of complex managed care payer financial modeling and statistical analysis to evaluate the feasibility of payer reimbursement methodologies.
Advises Alliance executive leadership on organizational decision-making through the performance of complex financial analysis to support successful payer reimbursement outcomes.
Acts as subject matter expert and collaborates with internal and external stakeholders to achieve payer reimbursement objectives.
Acts as a subject matter expert and lead to subordinate staff.
ABOUT THE TEAM
The Payment Strategy department ensures the Alliance's payments to our network are adequate to our revenue.
WHAT YOU'LL NEED TO BE SUCCESSFUL
Knowledge of:
Methods and techniques of financial modeling and analysis.
Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers.
Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types.
Healthcare financial statements and accounting principles.
Descriptive statistical techniques and terminology and the principles and practices of statistical analysis.
Methods and techniques of developing and delivering data management strategies that support contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations.
Thorough knowledge of the methods and techniques of valuating for physician and inpatient and outpatient hospital costs.
Ability to:
Collect, interpret, and evaluate data, detect patterns, brainstorm solutions, consider multiple factors when making decisions, and project consequences of recommendations.
Demonstrate strong analytical, critical thinking, and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action.
Translate data into understandable information and deliver solutions that improve business processes.
Act as a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs.
Lead, train, mentor and motivate staff, and promote an atmosphere of teamwork and cooperation.
Organize and prioritize the work of others and follow up on work assignments.
Education and Experience:
Bachelor's degree in Business Administration, Accounting, Finance, Healthcare, or a related field.
A minimum of eight years of experience performing financial healthcare reimbursement analysis (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying.
OTHER INFORMATION
We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
The full compensation range for this position is listed by location below.
The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).
OUR BENEFITS
Medical, Dental and Vision Plans.
Ample Paid Time Off.
12 Paid Holidays per year.
401(a) Retirement Plan.
457 Deferred Compensation Plan.
Robust Health and Wellness Program.
Onsite EV Charging Stations.
And
many more .
ABOUT USWe are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer.
Join us at Central California Alliance for Health (the Alliance), an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors, and people with disabilities in Mariposa, Merced, San Benito, and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our
Fact Sheet .
At this time, the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.
#J-18808-Ljbffr